[Os epilunatum is a rare cause of atraumatic impaired motility and wrist pain]

In this case report a 28-year-old man had a six-year history of atraumatic wrist pain. X-ray and MRI showed an accessory ossicle dorsal to the lunate, near the scapholunate ligament: an os epilunatum. Os epilunatum is a rare ossicle of the hand, and only one clinical case and few cadaveric studies have previously been reported. Resection was performed through a dorsal approach, without damaging the scapholunate ligament. Three months post-operatively the patient had increased motility of the hand and no pain.

Radiological and clinical analysis of Madelung's deformity in children

INTRODUCTION

Madelung's deformity is a bone dysplasia that occurs predominantly in adolescent females, characterized by early epiphyseal growth arrest in the medial part of the distal radius. This leads to an upward and medial displacement of the radial joint surface, restricting range of motion.

OBJECTIVES

The objective of this study was to determine whether there was a link between clinical and radiological data in children with Madelung's deformity and to test the hypothesis of a relation between the deformity and a genetic mutation.

METHODS

A retrospective study recruited 13 patients with Madelung's deformity, with a mean age of 13.2 years (range, 8-18 years). Assessment comprised level of pain, range of motion and grip force, with standard AP and lateral wrist X-rays. Every patient except one underwent molecular genetic screening, adhering to current recommendations.

RESULTS

Pronation-supination, radial inclination and grip force were significantly impaired compared to normal results. All X-ray measurements were significantly abnormal, except for the lunate-covering ratio. Genetic mutation (SHOX) was systematic in the 12 patients screened.

DISCUSSION

Radiological deformity did not correlate with functional disturbance or pain. Non-acquired Madelung's deformity requires molecular screening for SHOX or XO mutation, which definitively diagnoses Léri-Weill dyschondrosteosis or Turner syndrome.

CONCLUSION

A larger series is necessary to confirm these preliminary results, which nevertheless suggest that non-acquired Madelung's deformity is not isolated but syndromic. Early detection of Léri-Weill or Turner syndrome is essential, due to their therapeutic specificities. LEVEL: IV.

Madelung's deformity: diagnostic thresholds of radiographic measurements

PURPOSE

Although the x-ray changes of advanced Madelung's deformity are well described, little quantitative information exists on the subtle, early changes of the deformity. This study investigated the threshold of 4 radiographic measurements that predict a diagnosis of Madelung's deformity by experienced hand surgeons.

METHODS

Ulnar tilt, lunate subsidence, lunate fossa angle, and palmar carpal displacement were measured on x-rays of patients with Madelung's deformity. For each set of x-rays 4 opinions were available concerning a diagnosis of Madelung's deformity as based on the x-rays only. The 4 quantitative measurements were examined to determine a threshold value that predicts a unanimous diagnosis of Madelung's deformity.

RESULTS

The thresholds for the diagnosis of Madelung's deformity are: ulnar tilt of 33 degrees or greater, lunate subsidence of 4 mm or more, lunate fossa angle of 40 degrees or greater, and palmar carpal displacement of 20 mm or more. When any one of these measurements equaled or exceeded this threshold value, the raters were unanimous in establishing a diagnosis of Madelung's deformity.

CONCLUSIONS

Threshold values of ulnar tilt, lunate subsidence, lunate fossa angle, and palmar carpal displacement for the diagnosis of Madelung's deformity are determined. Lunate fossa angle may prove especially useful in the diagnosis of early Madelung's deformity.

Radiographic spectrum of severity in Madelung's deformity

PURPOSE

To establish whether Madelung's deformity demonstrates a radiographic continuum of severity and whether a forme fruste does exist.

METHODS

Ulnar tilt, lunate subsidence, palmar carpal displacement, and lunate fossa angle were measured in 81 wrist radiographs with obvious or suspected Madelung's deformity. Statistical analyses based on these measurements were performed to ascertain if there is a deformity continuum.

RESULTS

Ranges of 15 degrees to 51 degrees (mean, 28 degrees) for ulnar tilt, -7 to +11 mm (mean, -0.8 mm) for lunate subsidence, 9 to 25 mm (mean, 15.3 mm) for palmar carpal displacement, and 20 degrees to 56 degrees (mean, 33 degrees) for lunate fossa angle were obtained. Significant correlations were observed between all measurements.

CONCLUSIONS

Madelung's deformity encompasses a spectrum of radiographic abnormality.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic I.

Incomplete scapholunate and trapeziotrapezoid coalitions with an accessory carpal bone

Coalitions of the carpal bones associated with accessory carpal bones are relatively uncommon. We present a case of scapholunate and trapeziotrapezoid incomplete coalition with a dorsally situated accessory bone between trapezium and trapezoideum. X-ray, computed tomography, and magnetic resonance imaging findings of the patient are discussed in light of the pertinent literature.

Unilateral congenital absence of the lunate and scaphoid

We report a patient with unilateral absence of the scaphoid and lunate bone of the wrist. Remarkably he had severe osteoarthritis in several other joints.

Ulnar variance and the shape of the lunate bone. A radiological investigation

The authors designed a study to test the hypothesis that the length of the ulna might affect the shape of the lunate bone because of long-term molding during life. This might then be useful to predict the presence or absence of a dynamic or static ulna plus by the shape of the lunate bone. In a prospective study, posterior-anterior wrist x-rays were taken in a standard fashion in 68 patients with a mean age of 34.5 years. Dominance, grip strength, ulnar variance and the shape of the lunate were recorded. Lunate shape, type 1, which is the least molded, was seen most frequently on both the left and right side and did not correlate with the dominant side. The most molded, type 3, was seen less frequently and almost exclusively on the nondominant side. No correlation was found between dynamic ulna plus and the type 3 lunate. Following statistical analysis, no correlation between ulnar variance and lunate shape was found, indicating that the shape of the lunate bone had no predictive value for predicting the presence or absence of a dynamic ulna plus variance. The hypothesis that the length of the ulna might influence the ultimate shape of the lunate could not be demonstrated.

[Fracture of the lunatotriquetrum bone in the triquetral part. Case report and review of the literature]

The fusion of the lunate and triquetrum is the most common type of carpal fusion. Fractures of the os lunatotriquetrum are rare and usually occur at the point of union. In our case we found an isolated transverse fracture of the triquetral part of the fused bone without dislocation. In case of non-union, the differential diagnosis of an incomplete fusion must be taken into consideration.

[The os lunato-triquetrum]

The os lunato-triquetrum is a fusion of the lunate with the triquetral bone. It is the most frequent anomalie of the carpe and nearly always asymptomatic. The coalition is mostly an isolated event or part of a syndrome of multiple anomalies. A case report of four patients with an synostosis between the lunate and the triquetrum is represented, two of them were members of African people. The high incidence in Africa and the geographical distribution of the described anomalie in black people of African descent are seen - under anthropological points of view - as ethnogenetic and ethnohistorical events.

[Bilateral lunato-triquetral synostosis with bilateral fracture of the scaphoid bone]

The authors have treated a case of bilateral fracture of the scaphoid bone in a young man who had complete and bilateral lunato-triquetral synostosis, without any other associated congenital condition. Consolidation was obtained by orthopedic treatment on one side, but a Matti-Russe operation was necessary on the other. The authors emphasize but then rule out the hypothesis of a congenital bipartite scaphoid associated with the synostosis. A review of the literature on lunato-triquetral synostoses sums up the main points. The condition is rare in whites and occurs more frequently in blacks. It is sometimes associated with other congenital conditions. Four anatomic and radiologic types have been described. The pathogenic hypotheses, based on embryology, are summarized.

[Os lunatum partitum: critical comment on the contribution of C.Hoffmann]

This paper refers to the case published in "Handchirurgie" 14, 109-113 (1982). The author has conducted a critical analysis of the original records and of the literature. He concludes that the diagnosis is one of necrosis of the lunate (Kienböck's disease), not os lunatum partitum.

[Bipartite lunate bone]

A review on the existing literature shows that the os lunatum bipartitum is an rarely seen morphological variation of carpal bones. Clinical and radiological sings and the resulting treatment are demonstrated at a patient suffering from such an abnormality. The differential diagnostic problems as to the etiology of similar skeletal alterations are discussed.

Bilateral ulnar "thumbs"

Congenital fusion of the carpal bones is fairly common and may be associated with other congenital deformities in the hand. This report deals with an unusual congenital anomaly of the little fingers associated with fusion of the triquetrum and lunate. Both little fingers were adducted and rotated giving crude resemblance to thumbs on the ulnar borders of the hands. The deformity was easily corrected by osteotomy through the base of the fifth metacarpals.